Friday, August 14, 2009

mcjoan @ Netroots Nation: "Howard in the House!!"

mcjoan (daily kos):
We're ready for a barn-burner from the good doctor here at Netroots Nation, if his interview with Sam Stein yesterday is any indication.

"I do think there will be primaries as the result of all this, if the bill doesn't pass with a public option," Dean said, in a phone interview with the Huffington Post....

As he has done before, Dean criticized talk of substituting a government run program with co-operative insurance plans, calling the latter a "fig leaf."

"This talk about co-ops is a political compromise it is not a policy compromise," he said, of the discussions currently underway in the Senate Finance Committee. "And I think most people, on both sides of the aisle know that co-ops won't work."

Asked about a column by long-time Democratic strategist Paul Begala, urging progressives not to shy away from tackling health care in a more incremental approach, Dean shot back: "The public option is incrementalism.... But there is no incrementalism without the public option." He explained: "If you don't have a public option this bill is not even incremental, in terms of adequate health care reform... Paul is not entirely wrong. It is just that the last shred of reform is the public option."

So follow along and I'll try to keep up here liveblogging. And of course, we're streaming it (the video is down below).



Update: You can use Twitter to send in questions: #DeanNN

Update 2: Current system will not work to control costs--ever. Have to have public option simply to control those costs.

Update 3: On the "death panel." "These town hall meetings are not about health care." People angry for 3 reasons--Rs have been angry for 30 years and the leaders have exploited that--polling for anger points. Second--who is shouting their congresspeople down? Not the generation that elected Obama--these are the people who feel threatened. As they get smaller they get angrier. Third--a president they're not accustomed to seeing in the WH. Change is hard.

Update 4: Q on reproductive rights--will our reproductive rights/womens health care remain protected? A: Will only probably be relevant to public option--Congress not designing benefit package, but by separate panel. People who have injected this issue into the debate are the people trying to derail the bill. Debate we're now seeing ought to be handled not by putting in language to prevent reproductive health care, but to put it in the hands of the panel. We're much safer having this issue dealt with by people who aren't politically influenced.

Update 5: Q: have the politics changed enough to get it done this time? A: we know we're winning now by the desperation of the other side. Blue Dog positive influence because you have to have someone from the moderate/conservative side represented, since the Rs refuse to participate. The $500,000 exemption for small businesses good. Would be a "huge boost" to small business. "We're in good shape on this bill." There will be a good bill in the House with a strong public option, the Dodd bill is good. Thinks it will end up in reconciliation in the Senate.

Update 6: Q: why didn't the Dems start with single payer? Was it a strategic mistake? How do we make the public option the centrist option? A: It was a mistake. Leadership somehow thought single payer had become like the word "liberal" and that by taking it off the table we'd have a reasonable debate. Debate is done, Rs aren't interested regardless. SP is more efficient, controls administrative costs (4% overhead compared to upwards of 20%)--would have had a better, more comprehensive debate if it had been on the table.

Update 7: Q: How do we get more providers in the debate? A: AMA has endorsed E&C bill--great accomplishment. Significant majority of primary care docs support SP. Some docs are worried, but they're not dumb. They realize they're better off with real reform and that we need change.

Update 8: Q: What can be done to create economic incentives for more people to go into primary care? Is there anything in the existing bills will help? A: Ironically Blue Dogs helped because Medicare rates are too low. Need to raise reimbursement rates for primary care. Need to lower debt from med school, so that they're not attracted to specialties to make more money and pay their loans. Use qualified medical staff like nurse practitioners, physician assistants and get people used to going to them for primary care. And more federally qualified health care centers. (But DemFromCT says that they have limited hours and often have to send their patients on to ERs after hours).

Update 9: Q: How do I frame the hcr debate when I talk to my representative? A: First, who gets to choose? The people or Congress and the insurance companies? Second, American people have made very clear that they want choice, so ask your representative whether they represent you or the insurance companies, and remind them that you'll be having that discussion with them again in 2010. Follow-up: the public option will make the insurance companies honest. The problem is the insurance companies are just an extension of what's been going on on Wall St. They're in it for profit, not for health care.

Update 10: Q: How do we make this bill affordable for middle class as well as low-income people? A: The key is the public option. The stakes are so high for that that it's not worth fighting over anything else. The fee-for-service system needs to change, docs don't particularly like it. So there will be cost controls, and the public option will lead the way.

Update 11: Q: How do we keep medical innovation in reform? A: There is a critical role for private sector--we need to keep the extraordinary innovation of pharmaceuticals and med tech companies. The other role for the private sector is employers to encourage healthier lifestyles. That's an investment in prevention that works. We don't need to run away from what the private sector does right.

Update 12: Q: What about "bipartisanship"? Should he keep working with the Rs? A: The tactic of allowing the Rs to show their true colors to the American people is smart. BUT--bipartisanship shouldn't be the goal. A good bill needs to be the goal.

Update 13: Q: What about co-ops? A: They're a "waste." They're too small. We've already tried it (Blue Cross/Blue Shield) and they got eaten up by the big insurance companies. We don't want to do anything to help the insurance companies. We want them to serve us better. In the long term the co-ops will fail and be crushed. They are a political compromise that will not work.

Update 14: Q: How do we make sure that we have mental health parity in the reform? A: The brain is an organ that needs to be treated like any other organ. There should be no limits on mental health coverage. Hopes that the panel will do that.

Update 15: Q: How do we keep the message on the public option clear? A: We don't spend all our time refuting the BS. This debate is about two things: are we going to allow the American people to choose for themselves? Will they get a full range of choice, or does Congress and the insurance companies get to choose? The second part is who are you representing: are you standing up for the American people or the insurance companies.

Update 16: Q: If the public option passes, will it become the dumping ground for high risk, otherwise uninsurable people? A: No--because guaranteed issue and community rating will be in the bil--they have to let everybody in to private plans. There is a higher proportion of people in the uninsured pool who are higher risk, so uninsured pool might be more likely to sign up for public option and there might be more high risk people in it. But it won't make the public option fail because it has more room for increased risk because it's more efficient. But the reality now is that we're paying for it anyway because these people do need care now--in ERs and in public hospitals. We're paying for these people anyway, and the care will be must more rational in a public system.

Update 17: Q: On exempting small businesses from employer mandate--in 1993-4 there was backlash from medium and large business because of level of subsidies to small business. Will that happen again? A: Small business create 80% of new jobs in America, so this should be even more small business friendly. The large businesses will just have to deal.

If he was in charge? He'd give everybody under 30 for free, and not have mandates. You can't make the under 25 crowd do anything, so forcing them to have health insurance doesn't work. It's the hardest group to sign up for anything. For the over 55s, they could buy into Medicare. Wouldn't create a separate public option but open up Medicare to more people. Wouldn't do away with employer based insurance, even though it's not great. You can't change the system that drastically yet.

But Obama's bill gives us choice. Instead of trying to force everyone out of the system we already have, we need to let people choose what they want--including what they have now if they like it. Allows the pace of reform to go at the pace the American people is comfortable with.

Update 18: Q: How do we help? What does the netroots do to make this happen. A: Speaking as a paid consultant for DFA, go to DFA and take action there. Talk to your Dem Senators and remind them that we are supporting the Democratic President's plan, but only your Senators. Contact your friends in the states of the people who need to be pressured, and encourage them to call their reps.

Majority Dem caucus wants public option, Senate Finance will have to recognize that. We can be polite, but be firm. We've already made our compromise, and there will be no more. The Democratic Congress needs to support the Democratic President (and the crowd goes wild!).
Howie P.S.: Politico interviewed Dean yesterday in a bookstore where he was doing a book-signing: "Howard Dean responds to 'outlandish' health claims."

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